title: [Positioning Injuries to Peripheral Nerves during Laparoscopic Colon and Rectum Surgery].
abstract: Laparoscopic colon and rectum operations expose peripheral nerves to risk due to extreme patient positions needed to achieve gravity displacement during the surgical procedures. The general incidence of position-caused nerve injuries in surgery is not well known and is estimated to be about 0.5 % in the literature. There are no current data concerning laparoscopic operations. This study assesses the incidence and outcome of surgery-associated neurological symptoms after laparoscopic colon and rectum surgical procedures. We analysed the number of position-caused nerve injuries and their outcome from 1992-2010 in a prospectively managed data base. Risk factors like age, BMI, procedure duration and abduction of the upper extremities were analysed. There were 19 (0.7 %) position-caused nerve injuries among 2698 laparoscopic operations on the colon and rectum. The incidence of surgery-associated neurological symptoms was 1.08 % after laparoscopic rectum and 0.54 % after laparoscopic colon surgical procedures. Both operation time (267 vs. 185 minutes) and BMI (27.93 vs. 25.79 kg/m(2)) were revealed as risk factors for position-caused nerve injuries. Adduction of the upper extremities reduced the incidence of positioning nerve injuries from 0.23 % to 0.1 %. Postoperative neurological symptoms were in most cases reversible (89.47 %). The incidence of postoperative nerve injuries since 2007 is low after laparoscopic rectum and colon operations and is mostly completely reversible. Both procedure duration and BMI are probable risk factors for surgery-associated nerve injuries. Adduction of the upper extremities provides an opportunity to reduce position-caused nerve injuries.
authors.affiliation: Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland.
authors.forename: D B
authors.initials: DB
authors.lastname: Ellebrecht
authors.affiliation: Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Wolken
authors.affiliation: Penn Skin Disease Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors.forename: C T
authors.initials: CT
authors.lastname: Ellebrecht
authors.affiliation: Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland.
authors.forename: H-P
authors.initials: HP
authors.lastname: Bruch
authors.affiliation: Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Kleemann
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003108:Colonic Diseases / Q000601:surgery*; D003161:Compartment Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D056888:Patient Positioning / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D059348:Peripheral Nerve Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011379:Prognosis; D012002:Rectal Diseases / Q000601:surgery*; D012307:Risk Factors